Healthcare Provider Details

I. General information

NPI: 1801963814
Provider Name (Legal Business Name): JORGE L. LLANES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 W SUNSET BLVD
LOS ANGELES CA
90027-6021
US

IV. Provider business mailing address

4733 W SUNSET BLVD
LOS ANGELES CA
90027-6021
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-4011
  • Fax:
Mailing address:
  • Phone: 323-783-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA41319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: